Cognitive domains
In characteristic 1, we wrote that cognitive decline occurs in one or more cognitive domains.
Which ones are these?
Executive functions
Recall the example of the family gathering we just discussed. Organizing a big party requires executive functions: planning, reasoning, coordinating, making decisions, … This becomes difficult once you have dementia.
A testimonial:
“Cooking has become incredibly complex and almost overwhelming for me. I need to arrange ingredients as per the recipe, use them in order, and then store them away to avoid using them twice. I find myself having to write down every step. It’s exhausting because it consumes my entire day.”
Christine Bryden, Dancing with dementia
Examples of symptoms?
Complex tasks become difficult, you have difficulty making decisions and keep doubting, you take less initiative, you have difficulty stopping an action spontaneously, you have difficulty dealing with change, you exhibit disinhibited behavior, …
Learning and memory
Let’s take a moment to examine this last example. Time never stands still. For those who cannot remember what time it is, this is very disorienting.
What’s often observed in individuals with dementia is a sense of disorientation in…
… time
What time is it?
… space
Where am I?
… persons
Do I know you?
Language
• word-finding problems
• hollow words, such as “that thing,” “you know”
• peculiar word usage, such as “the sunstrasition” instead of the sunset
• a meaningless flow of words
• not understanding what others tell you
• grammatical errors
• stereotypical speech, e.g., “One time like this and one time like that”, without concrete cause
•compulsive repetition of words E.g. “Take your coat” “Coat” “Do you want to go to the toilet again before we leave?” “Coat”
Perceptual motor
Sometimes, individuals with dementia don’t recognize the purpose of common objects like a fork or a washcloth. This condition is termed apraxia. Have you encountered this before?
Moreover, a common feature of dementia is heightened agitation during nightfall and an increased susceptibility to illusions. For instance, a coat hanging on a rack might be mistaken for a stranger in the room, leading to a frightening experience.
Social cognition
An example: Place the flower boxes on a cupboard instead of on the ground. This way, the chance that someone with dementia will urinate in it is very small.
The following case contains many elements of loss of decorum that we have already discussed.
“In the early stages of her dementia, Anna had quickly become a completely different person socially. She gave people nicknames. She sat on strangers’ laps and kissed everyone, which was inappropriate under the circumstances. She did this as much with her boss, as with her colleagues, as with someone she was seeing for the first time.”